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Reminder for patient out-of-pocket vaccine costs

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In January the Federal Government announced 16 temporary MBS item numbers for COVID-19 vaccines would be available from March.
 
Clarity on billing for items was welcomed by the RACGP, with the new item numbers enabling GPs and other healthcare professionals to assess patients for their vaccine suitability, based on provider status, location, business or after-hours, first or second dose.
 
For the purpose of claiming an MBS item, the Department of Health (DoH) advises that GPs and other healthcare providers ‘are responsible for using their professional judgment to determine the most clinically appropriate services to provide’.
 
GPs are also responsible for ensuring any services billed to Medicare fully meet the eligibility requirements outlined in the legislation, including that they privately bill for a usual consultation with a patient, but the item claimed for administering the vaccine must be bulk billed.
 
However, concerns and confusion remain around patients being faced with out-of-pocket fees when receiving their COVID-19 vaccine at a general practice, particularly for patients from culturally and linguistically diverse (CALD) backgrounds.
 
To address this, the DoH and National COVID Vaccine Taskforce have provided newsGP with further guidance aimed at helping GPs to fulfil their integral role in the vaccine rollout.
 
As patients from CALD backgrounds may be among those who are confused or hesitant around receiving the vaccine, the DoH says it is important that all participating practices understand that patients should not be charged for a COVID vaccine.
 
GPs should also be aware that patients who are non-Medicare card holders are also eligible to receive the vaccine at no charge, and that they cannot claim an MBS item.
 
Further to that, as receiving the vaccine is not dependent on visa status, it is not suitable for patients to be asked about this.
 
‘The vaccine hesitancy we have seen in Australia is exacerbated for asylum seekers without Medicare for a number of reasons,’ Dr Rebecca Farley, Chair of RACGP Specific Interests Refugee Health, recently told newsGP.

‘As GPs, it is essential that we are aware that every person in Australia, irrespective of Medicare status, can receive the COVID-19 vaccine for free, when they are eligible.
 
‘We also need to know how to support every person in Australia to access the vaccine.’
 
If a patient does not have a Medicare card, or is not eligible for Medicare, they can be directed to their closest Commonwealth vaccination clinic, community pharmacy or state or territory vaccination site. Alternatively, vaccine providers can administer the COVID-19 vaccine but cannot bill for this service.
 
The DoH recommends general practices ask patients about their Medicare status before taking COVID-19 vaccination bookings.
 
As part of the National COVID Vaccine Taskforce’s (the Taskforce) ongoing collaboration with general practices throughout the rollout, it has outlined the following guidance: 

• COVID-19 vaccine MBS items must be bulk billed. Practices cannot charge a patient any cost associated with the administration of the COVID-19 vaccine, including booking fees for Medicare eligible or ineligible patients.
• Participating practices are encouraged to book a patient’s COVID-19 MBS vaccination suitability assessment as a standalone appointment.
• If a practice does not follow the requirements for administering COVID-19 vaccines, the practice may be paused and/or withdrawn from administering the vaccines where suspected non-compliance has been investigated and the actions found non-compliant. This includes charging patients for COVID-19-related services.
• To participate in the vaccine program, practices are required to sign a vaccine declaration form agreeing to and meeting ATAGI site requirements. One of the conditions within the declaration is they must provide COVID-19 vaccination services free of charge to patients.

The DoH and the Taskforce caution that allegations of Medicare non-compliance by healthcare providers are taken ‘very seriously’ and will be reviewed in accordance with compliance assessment procedures.
 
Both the DoH and the Taskforce will also continue to work closely with general practices, including if they have not complied with requirements of the vaccine program ‘due to genuine mistakes’, as well as ensuring any patients who received out-of-pocket expenses are reimbursed.
 
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CALD COVID-19 MBS vaccine rollout

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